| NPI | 1477169605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 107974) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 89589) |
| 2084H0002X Psychiatry & Neurology, Hospice and Palliative Medicine (Licence: CA 107074) | |
| Enumeration Date | 2020-09-22 |
| Last Update Date | 2022-10-05 |