| NPI | 1649830795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 13497) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA APCC5863) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2024-09-17 |