| NPI | 1700436102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 110997) |
| Additional Taxonomies | 104100000X Social Worker |
| 171M00000X Case Manager/Care Coordinator | |
| 225400000X Rehabilitation Practitioner | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-09-17 |
| Last Update Date | 2023-06-23 |