| NPI | 1306274576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA ACSW94083) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 225400000X Rehabilitation Practitioner (Licence: CA 60138) | |
| Enumeration Date | 2013-10-24 |
| Last Update Date | 2021-04-30 |