| NPI | 1407744550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 138346) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA 002093) |
| Enumeration Date | 2025-06-26 |
| Last Update Date | 2025-06-26 |