| NPI | 1336033364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA ASW128234) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW128234) |
| Enumeration Date | 2025-06-04 |
| Last Update Date | 2025-08-04 |