| NPI | 1033620067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW106173) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 79070) |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2022-01-06 |