| NPI | 1760102982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 20798) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 20798) |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2025-12-17 |