| NPI | 1114691912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 14145) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW113458) |
| 101YM0800X Counselor, Mental Health (Licence: CA 113458) | |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2026-09-15 |