| NPI | 1275186512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 118269) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 844882599) |
| 1041C0700X Social Worker, Clinical (Licence: CA 87984) | |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2024-01-08 |