| NPI | 1760760748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L6258) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR L6258) |
| 101YM0800X Counselor, Mental Health | |
| 104100000X Social Worker (Licence: CA ASW31528) | |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2020-12-02 |