| NPI | 1780137141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 100849) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: CA 100849) |
| 101YM0800X Counselor, Mental Health (Licence: CA 100849) | |
| 101YM0800X Counselor, Mental Health (Licence: CA ASW62577) | |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2024-12-12 |