| NPI | 1871992560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 73654) |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker (Licence: CA 73654) | |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2016-09-30 |