| NPI | 1730805649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LPC-9697) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA APCC12479) |
| Enumeration Date | 2022-10-13 |
| Last Update Date | 2025-12-17 |