| NPI | 1578164364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA ASW99705) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2020-11-06 |
| Last Update Date | 2021-02-08 |