| NPI | 1992377360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 104833) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 32026) |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2026-01-20 |