| NPI | 1497897664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 481489) |
| Additional Taxonomies | 251S00000X (Licence: CA 481489) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-07-08 |