| NPI | 1487102091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW114245) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCSW11424) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2023-03-23 |