| NPI | 1023266996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCSW79706) |
| 101Y00000X Counselor | |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2022-08-12 |