| NPI | 1659532976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 104750) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2025-02-14 |