| NPI | 1962925693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 108774) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 91232) |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2022-08-10 |