| NPI | 1295126472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 107241) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2015-02-10 |
| Last Update Date | 2022-03-15 |