| NPI | 1174087696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA LPCC5986) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 12828430-6004) |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2025-10-23 |