| NPI | 1982030409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 83054) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW68025) |
| Enumeration Date | 2013-09-16 |
| Last Update Date | 2019-02-15 |