| NPI | 1962922740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 84609) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 102888) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2026-01-07 |