| NPI | 1659801330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA ASW78616) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW78616) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2022-07-21 |