| NPI | 1801513403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA ASW105056) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW105056) |
| Enumeration Date | 2022-10-24 |
| Last Update Date | 2022-10-27 |