| NPI | 1669053633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 127367) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 98436) |
| 104100000X Social Worker (Licence: CA 98436) | |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2024-12-03 |