| NPI | 1467855262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C.1400113) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA PCCI1997) |
| Enumeration Date | 2014-10-07 |
| Last Update Date | 2026-08-04 |