| NPI | 1528390234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 29211) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW23747) |
| Enumeration Date | 2010-02-04 |
| Last Update Date | 2013-01-25 |