| NPI | 1255630323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 97219) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 97219) |
| 225400000X Rehabilitation Practitioner | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-03-15 |
| Last Update Date | 2021-06-15 |