| NPI | 1235835935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 1125952) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 1129552) |
| Enumeration Date | 2023-02-03 |
| Last Update Date | 2024-11-25 |