| NPI | 1093947376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 77673) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 29148) |
| 1041C0700X Social Worker Clinical | |
| 101YM0800X Counselor Mental Health (Licence: CA 77673) | |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2021-10-17 |