| NPI | 1639594260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW80432) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 1041C0700X Social Worker Clinical (Licence: OR LCSW12241) | |
| Enumeration Date | 2014-02-18 |
| Last Update Date | 2025-05-14 |