| NPI | 1851687701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 122045) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2024-06-17 |