| NPI | 1992163034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 101795) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 84644) |
| Enumeration Date | 2016-02-03 |
| Last Update Date | 2023-09-26 |