| NPI | 1023691342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA LPCC16880) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC0017795) |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2026-06-16 |