| NPI | 1235994278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 120182) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 120182) |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2025-10-07 |