| NPI | 1124779582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 108710) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 108710) |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-01-17 |
| Last Update Date | 2023-06-16 |