| NPI | 1225712581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA 137666) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2023-06-14 |