| NPI | 1295344133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 98257) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 98257) |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2021-04-20 |