| NPI | 1790064012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 88422) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 33235) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2020-04-17 |