| NPI | 1306533443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 137486) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 115015) |
| Enumeration Date | 2023-04-19 |
| Last Update Date | 2026-03-26 |