| NPI | 1710322821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 95506) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA F5073237) |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2020-07-14 |