| NPI | 1437622883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CA 5250) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 5250) |
| Enumeration Date | 2019-01-08 |
| Last Update Date | 2023-05-04 |