| NPI | 1215634712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 16606) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 5840) |
| Enumeration Date | 2023-02-14 |
| Last Update Date | 2024-07-08 |