| NPI | 1992947295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA 73817) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 73817) |
| 1041C0700X Social Worker Clinical (Licence: CA 73817) | |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2025-06-09 |