| NPI | 1598019382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 73384) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 34634) |
| Enumeration Date | 2012-11-01 |
| Last Update Date | 2018-03-17 |