| NPI | 1932536091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 67572) |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker (Licence: CA 67572) | |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2022-07-21 |