| NPI | 1104042928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 120764) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 75012) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2024-02-01 |