| NPI | 1811440233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 12458) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 3301) |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2022-11-11 |