| NPI | 1285191601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 106467) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 101YM0800X Counselor, Mental Health (Licence: CA 106467) | |
| Enumeration Date | 2019-02-21 |
| Last Update Date | 2023-06-27 |