| NPI | 1609399856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 89622) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 89622) |
| 1041C0700X Social Worker, Clinical (Licence: CA 89622) | |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2023-10-18 |