| NPI | 1780085043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 89178) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA ASW66588) |
| Enumeration Date | 2014-09-05 |
| Last Update Date | 2022-05-01 |