| NPI | 1881830065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 79317) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 25423) |
| 101YM0800X Counselor, Mental Health (Licence: CA ASW65093) | |
| Enumeration Date | 2008-12-18 |
| Last Update Date | 2017-09-20 |