| NPI | 1487955746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 82464) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: CA 63128) |
| Enumeration Date | 2010-11-03 |
| Last Update Date | 2018-02-21 |