| NPI | 1871246793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 240177) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 209809) |
| Enumeration Date | 2022-01-31 |
| Last Update Date | 2022-03-24 |