| NPI | 1215405121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA APCC18370) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA APCC18370) |
| Enumeration Date | 2018-11-08 |
| Last Update Date | 2026-07-08 |