| NPI | 1073981320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 99750) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 72158) |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2025-02-04 |