| NPI | 1124493861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 89984) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 68420) |
| Enumeration Date | 2015-12-07 |
| Last Update Date | 2020-02-26 |