| NPI | 1376943456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW109684) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 101YM0800X Counselor, Mental Health (Licence: CA ASW83935c) | |
| Enumeration Date | 2014-08-26 |
| Last Update Date | 2022-12-29 |