| NPI | 1629769906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 115318) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 115318) |
| Enumeration Date | 2023-05-17 |
| Last Update Date | 2023-07-12 |