| NPI | 1396289716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 7084) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA PCI 3068) |
| Enumeration Date | 2016-12-05 |
| Last Update Date | 2022-08-04 |