| NPI | 1124792650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CA 7475) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IN 24973) |
| 101YM0800X Counselor Mental Health (Licence: CA 7475) | |
| Enumeration Date | 2021-08-07 |
| Last Update Date | 2021-08-07 |