| 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 | 2023-11-08 |