| NPI | 1659939213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA LPCC15716) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 74276) |
| 102L00000X Psychoanalyst (Licence: CA APCC8010) | |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2024-05-06 |