| NPI | 1093169252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA APCC1190) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA PCCI, 1190) |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2024-08-13 |