| NPI | 1598589731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CA LPCC6930) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: PA PC008160) |
| Enumeration Date | 2024-11-13 |
| Last Update Date | 2024-11-13 |