| NPI | 1114419082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA ASW67403) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW67403) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2019-03-19 |