| NPI | 1457653172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA LCSW81630) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ASW65495) |
| 1041C0700X Social Worker Clinical (Licence: CA LCSW81630) | |
| Enumeration Date | 2010-12-01 |
| Last Update Date | 2021-11-17 |