| NPI | 1962766154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW108942) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW84452) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2024-02-25 |