| NPI | 1144973553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 130789) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 11074) |
| Enumeration Date | 2022-01-27 |
| Last Update Date | 2022-03-08 |