| NPI | 1073491890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CA APCC20355) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA APCC20355) |
| Enumeration Date | 2025-08-21 |
| Last Update Date | 2026-07-21 |