| NPI | 1598323388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 125762) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 109495) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2023-12-29 |