| NPI | 1245903921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA LPCC13279) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA LPCC13729) |
| Enumeration Date | 2021-07-28 |
| Last Update Date | 2026-03-30 |