| NPI | 1528411659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 59978) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2021-07-06 |