| NPI | 1558832717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 108999) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2024-01-04 |