| NPI | 1265780662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 94717) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ACSW 66649) |
| 101YM0800X Counselor Mental Health (Licence: 94717) | |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2022-02-10 |