| NPI | 1154094886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA ACSW102024) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2021-07-28 |
| Last Update Date | 2022-09-08 |