| NPI | 1215447305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 16900) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2017-10-03 |
| Last Update Date | 2026-04-30 |