| NPI | 1043769474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 92959) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 80611) |
| 104100000X Social Worker (Licence: NY 098338) | |
| Enumeration Date | 2016-09-27 |
| Last Update Date | 2022-01-14 |