| NPI | 1699306688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CA 18882) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 4896) |
| Enumeration Date | 2020-01-29 |
| Last Update Date | 2025-04-07 |