| NPI | 1639710718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 12212) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH61144397) |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2022-11-10 |