| NPI | 1689198764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW103340) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 83293) |
| 101YM0800X Counselor, Mental Health (Licence: CA LCSW103340) | |
| 1041C0700X Social Worker, Clinical (Licence: CA 103340) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-07-31 |
| Last Update Date | 2023-04-19 |