| NPI | 1679807499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW63280) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NM X-06721) |
| 101YP2500X Counselor, Professional (Licence: NM I-07957) | |
| Enumeration Date | 2009-09-25 |
| Last Update Date | 2024-05-31 |