| NPI | 1427394626 |
|---|---|
| Professional Name | N/A N/A N/A |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 9447) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 9447) |
| Enumeration Date | 2012-12-17 |
| Last Update Date | 2025-10-30 |