| NPI | 1023343050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW68914) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 1041C0700X Social Worker Clinical (Licence: CA 68914) | |
| Enumeration Date | 2009-10-08 |
| Last Update Date | 2021-07-28 |