| NPI | 1063727105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW69400) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ASW32706) |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2021-03-17 |