| NPI | 1457822926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 118552) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041S0200X Social Worker, School (Licence: CA 118552) | |
| Enumeration Date | 2018-12-10 |
| Last Update Date | 2023-10-26 |