| NPI | 1033770367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 16813) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 6611) |
| 101YP2500X Counselor, Professional (Licence: CA 6611) | |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2025-04-08 |