| NPI | 1992200612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 122552) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YM0800X Counselor, Mental Health (Licence: CA 82255) | |
| 104100000X Social Worker (Licence: CA 122552) | |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2025-05-09 |