| NPI | 1134519515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA ACSW97554) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2015-01-23 |
| Last Update Date | 2023-06-08 |