| NPI | 1952777641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 1952777641) |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2021-02-01 |