| NPI | 1396377495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 106562) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 106562) |
| Enumeration Date | 2020-02-06 |
| Last Update Date | 2022-09-19 |