| NPI | 1467939553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CA 15872) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YM0800X Counselor Mental Health (Licence: CA 6593) | |
| Enumeration Date | 2018-07-23 |
| Last Update Date | 2024-07-03 |