| NPI | 1952584401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW 25791) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ASW 20155) |
| Enumeration Date | 2007-12-06 |
| Last Update Date | 2022-01-26 |