| NPI | 1730387770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 108094) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 60419) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2026-03-11 |