| NPI | 1639635428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 111391) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 104100000X Social Worker | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2019-02-16 |
| Last Update Date | 2022-11-08 |