| NPI | 1194177410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CA 100040) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW65341) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2021-04-22 |