| NPI | 1073294104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 14202) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 14202) |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2024-02-13 |