| NPI | 1720219561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 42969) |
| Enumeration Date | 2009-07-28 |
| Last Update Date | 2025-11-15 |