| NPI | 1649054966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 71969) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34004843A) |
| 101YM0800X Counselor, Mental Health (Licence: CA 71969) | |
| 101YM0800X Counselor, Mental Health (Licence: IN 34004843A) | |
| 1041C0700X Social Worker, Clinical (Licence: NV 7049-C) | |
| 101YM0800X Counselor, Mental Health (Licence: NV 7049-C) | |
| Enumeration Date | 2023-08-21 |
| Last Update Date | 2023-08-21 |