| NPI | 1588238539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 405300000X Prevention Professional (Licence: CA 1588238539) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2021-05-14 |
| Last Update Date | 2024-04-30 |