| NPI | 1215229448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 94955) |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2023-06-07 |