| NPI | 1174965677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 61870) |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker (Licence: CA 61870) | |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2015-09-17 |