| NPI | 1669697165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA ASW89787) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW 21607) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2024-07-29 |