| NPI | 1043982812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA ACSW97183) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ACSW97183) |
| Enumeration Date | 2021-09-30 |
| Last Update Date | 2021-09-30 |