| NPI | 1639997927 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA ASW130714) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR A15666) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2024-09-26 |
| Last Update Date | 2025-08-06 |