| NPI | 1730746736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 110643) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW87471) |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2022-09-25 |