| NPI | 1306619036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 118862) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 118862) |
| Enumeration Date | 2023-11-03 |
| Last Update Date | 2025-09-23 |