| NPI | 1396441101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 12274) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 20930) |
| Enumeration Date | 2023-02-02 |
| Last Update Date | 2025-11-06 |