| NPI | 1033245857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 25999) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2021-12-20 |