| NPI | 1457893398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW121883) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW83932) |
| Enumeration Date | 2016-11-09 |
| Last Update Date | 2025-11-20 |