| NPI | 1710010152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 17520) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 17520) |
| 101YM0800X Counselor, Mental Health (Licence: MI 6401009233) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2025-08-29 |