| NPI | 1154699130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical (Licence: CA 81431) | |
| Enumeration Date | 2011-12-06 |
| Last Update Date | 2019-05-24 |