| NPI | 1215678479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA APCC14838) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: CA TCH188802) |
| Enumeration Date | 2022-04-03 |
| Last Update Date | 2025-04-23 |