| NPI | 1235539792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 100743) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW71862) |
| Enumeration Date | 2014-09-02 |
| Last Update Date | 2022-07-14 |