| NPI | 1982953303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 76349) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 33223) |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2019-05-28 |