| NPI | 1215058334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CA 7810) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YP2500X Counselor Professional | |
| 101YP2500X Counselor Professional (Licence: CA 2774) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2020-05-04 |