| NPI | 1700138559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 75121) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 61989) |
| 1041C0700X Social Worker, Clinical (Licence: NM X-07762) | |
| 1041S0200X Social Worker, School (Licence: NM x-07762) | |
| Enumeration Date | 2012-10-03 |
| Last Update Date | 2018-11-21 |