| NPI | 1396936647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW29414) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ASW 22061) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2022-06-20 |