| NPI | 1689161317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA ASW93696) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 93696) |
| 1041C0700X Social Worker, Clinical (Licence: CA ASW93696) | |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2023-06-23 |