| NPI | 1407316383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 7796) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 3779) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2020-09-02 |