| NPI | 1093169450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 81458) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2018-11-07 |