| NPI | 1255996237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 8966) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 4001) |
| 101YP2500X Counselor, Professional (Licence: CA 4001) | |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2021-02-03 |