| NPI | 1730737453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 11627) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 008946-1) |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2023-10-09 |