| NPI | 1770953580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 125339) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW91195) |
| 101YM0800X Counselor, Mental Health (Licence: CA 91195) | |
| 104100000X Social Worker (Licence: CA ASW91195) | |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2024-08-28 |