| NPI | 1740726421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW67526) |
| 1041C0700X Social Worker, Clinical (Licence: CA ASW67526) | |
| Enumeration Date | 2017-01-18 |
| Last Update Date | 2023-03-06 |