| NPI | 1134722374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 137593) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 122478) |
| Enumeration Date | 2020-11-19 |
| Last Update Date | 2023-08-16 |