| NPI | 1417596461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA 11457) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CA APCC7205) |
| Enumeration Date | 2019-12-22 |
| Last Update Date | 2022-05-04 |