| NPI | 1003356296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 14111) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2017-03-07 |
| Last Update Date | 2023-06-21 |