| NPI | 1538480256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 29395) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 27948) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2013-06-19 |