| NPI | 1659695971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 26366) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 828) |
| Enumeration Date | 2010-03-15 |
| Last Update Date | 2024-03-14 |