| NPI | 1235804923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YS0200X Counselor, School |
| 104100000X Social Worker (Licence: CA 109559) | |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2025-04-18 |