| NPI | 1417681370 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 111558) | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 111558) | 
| Enumeration Date | 2022-07-14 | 
| Last Update Date | 2025-04-17 |