| NPI | 1790187151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA ASW72483) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCSW89355) |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2021-03-31 |