| NPI | 1639863046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 120345) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 120345) |
| Enumeration Date | 2023-06-07 |
| Last Update Date | 2024-06-11 |