| NPI | 1619486529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA 92579) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA 92579) |
| Enumeration Date | 2017-09-22 |
| Last Update Date | 2024-02-05 |