| NPI | 1063159333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 90892) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 90892) |
| 104100000X Social Worker (Licence: CA 90892) | |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2025-01-30 |