| NPI | 1740638121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 5791) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2022-01-07 |