| NPI | 1750969945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA LCSW129448) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical (Licence: CA LCSW129448) | |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2025-06-20 |