| NPI | 1699397596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA LPCC16877) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA APCC7454) |
| 101YM0800X Counselor, Mental Health (Licence: CA 7454) | |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2024-08-15 |