| NPI | 1710400460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 108951) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ASW84482) |
| 104100000X Social Worker | |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2023-08-01 |