| NPI | 1669513586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 137128) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA 33379) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2026-05-29 |