| NPI | 1962063271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 127011) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 127011) |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2025-08-01 |