| NPI | 1972657575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 76744) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 19184) |
| 104100000X Social Worker (Licence: CA LCSW76744) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2023-05-16 |