| NPI | 1174230759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA APCC19932) |
| Additional Taxonomies | 225800000X Recreation Therapist (Licence: CA 85884) |
| Enumeration Date | 2022-11-02 |
| Last Update Date | 2026-01-30 |