| NPI | 1922332899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 111964) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 83839) |
| Enumeration Date | 2009-09-25 |
| Last Update Date | 2022-12-08 |