| NPI | 1619370582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA ASW69844) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2016-03-15 |