| NPI | 1003689597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA APCC20577) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA APCC20577) |
| 101Y00000X Counselor | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2025-11-25 |