| NPI | 1063959674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 78414) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 104100000X Social Worker (Licence: NY 097384) | |
| Enumeration Date | 2017-01-21 |
| Last Update Date | 2020-05-21 |