| NPI | 1295425320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA ASW113373) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2023-05-11 |
| Last Update Date | 2023-05-11 |