| NPI | 1669755955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 88372) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 88372) |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2020-02-26 |