| NPI | 1053836973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 86200) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2017-08-11 |
| Last Update Date | 2021-09-23 |