| NPI | 1225167737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 51493) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 51493) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2023-01-30 |