| NPI | 1831845361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 102053) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 102053) |
| 106H00000X Marriage & Family Therapist (Licence: CA LCSW102053) | |
| Enumeration Date | 2022-02-23 |
| Last Update Date | 2024-08-14 |