| NPI | 1245999309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 98984) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 98984) |
| 104100000X Social Worker (Licence: CA 200177) | |
| Enumeration Date | 2021-12-15 |
| Last Update Date | 2022-01-18 |