| NPI | 1023764057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA ASW106197) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ASW106197) |
| 1041C0700X Social Worker Clinical (Licence: CA A106197) | |
| Enumeration Date | 2022-02-28 |
| Last Update Date | 2025-04-29 |