| NPI | 1477044931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 114243) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 80338) |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2023-06-07 |