| NPI | 1457921280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CA 126129) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA 126129) |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2024-11-12 |