| NPI | 1194261495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 95384) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 76859) |
| Enumeration Date | 2017-01-10 |
| Last Update Date | 2020-07-10 |