| NPI | 1861962235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW103794) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA ASW85762) |
| Enumeration Date | 2018-11-28 |
| Last Update Date | 2025-06-12 |