| NPI | 1255572392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 64002) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 25770) |
| Enumeration Date | 2009-03-19 |
| Last Update Date | 2015-01-19 |