| NPI | 1801307749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 101867) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ACSW83081) |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2021-07-16 |