| NPI | 1811194897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS 17993) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 1041C0700X) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2023-03-16 |