| NPI | 1962068908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 122430) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 87607) |
| 101YM0800X Counselor, Mental Health (Licence: CA 87607) | |
| Enumeration Date | 2019-05-15 |
| Last Update Date | 2024-06-26 |