| NPI | 1255838413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA ASW121172) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ASW81282) |
| 171M00000X Case Manager/Care Coordinator (Licence: 171M0000X) | |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2024-09-23 |