| NPI | 1669134763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 110699) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 110699) |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2021-10-06 |
| Last Update Date | 2023-07-10 |