| NPI | 1770075335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CA APCC5161) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA APCC5161) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2023-10-27 |