| NPI | 1831234640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCS 29577) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ASW 9358) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2013-07-03 |