| NPI | 1730325242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS 28963) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW 24829) |
| Enumeration Date | 2009-01-05 |
| Last Update Date | 2012-10-26 |