| NPI | 1447989405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CA 6762) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 6762) |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2022-07-28 |