| NPI | 1053854802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 123295) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2016-11-28 |
| Last Update Date | 2024-07-16 |