| NPI | 1114510161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 101075) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2021-02-19 |
| Last Update Date | 2022-04-21 |