| NPI | 1821467705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 106487) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 95-2225798) |
| Enumeration Date | 2015-09-21 |
| Last Update Date | 2023-05-09 |