| NPI | 1134315021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA ASW30911) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 30911) |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2015-03-20 |