| NPI | 1871234542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 121030) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2024-03-05 |