| NPI | 1124779582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 108710) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 108710) |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2022-01-17 |
| Last Update Date | 2024-09-06 |