| NPI | 1417775503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 1041C0700X) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO 101Y00000X) |
| 103TF0000X Psychologist Family (Licence: CA 103TF0000X) | |
| Enumeration Date | 2024-09-28 |
| Last Update Date | 2024-09-28 |