| NPI | 1790200772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA ASW78792) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 78792) |
| 101YM0800X Counselor, Mental Health (Licence: ACSW78792) | |
| Enumeration Date | 2017-08-10 |
| Last Update Date | 2023-09-12 |