| NPI | 1669028528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 92933) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 92933) |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2019-08-15 |
| Last Update Date | 2020-01-02 |