| NPI | 1336542422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CA 4995) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 4995) |
| 101YP2500X Counselor, Professional (Licence: CA 693) | |
| 225C00000X Rehabilitation Counselor (Licence: GA 00116134) | |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2025-03-10 |