| NPI | 1447631775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA asw6617) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW66117) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2015-07-07 |