| NPI | 1376834507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA ASW126233) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 25-QMHP-R-3487) |
| Enumeration Date | 2011-04-21 |
| Last Update Date | 2025-11-22 |