| NPI | 1740203280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA SW16707) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA LCS 16707) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2013-04-03 |