| NPI | 1487163002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA LPCC20665) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NM CCMH0217051) |
| Enumeration Date | 2017-09-26 |
| Last Update Date | 2026-01-09 |