| NPI | 1164883138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 105299) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 76078) |
| 101YM0800X Counselor, Mental Health | |
| 1041C0700X Social Worker, Clinical (Licence: CA 76078) | |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2021-12-14 |