| NPI | 1326441312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA ASW97254) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 63064) |
| 101YM0800X Counselor, Mental Health (Licence: CA ASW97254) | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2014-10-03 |
| Last Update Date | 2023-07-17 |