| NPI | 1811593585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 121998) |
| Enumeration Date | 2020-12-08 |
| Last Update Date | 2024-07-12 |