| NPI | 1043804511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 99455) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 121584) |
| Enumeration Date | 2021-02-25 |
| Last Update Date | 2024-03-19 |