| NPI | 1487094629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 10734) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA PC010452) |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2023-08-29 |