| NPI | 1992831127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 114858) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 74524) |
| 1041C0700X Social Worker Clinical (Licence: CA 112715) | |
| 1041C0700X Social Worker Clinical (Licence: CA 114858) | |
| 101Y00000X Counselor | |
| 101YM0800X Counselor Mental Health (Licence: CA 74524) | |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2023-06-22 |