| NPI | 1013683028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA 100679) |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2023-06-02 |