| NPI | 1982276754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA 102653) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA 102653) |
| 1041C0700X Social Worker Clinical | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2021-08-23 |