| NPI | 1891355707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 114249) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW89801) |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2023-10-25 |