| NPI | 1336879717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 12515) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 104100000X Social Worker | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2022-06-16 |
| Last Update Date | 2023-03-06 |