| NPI | 1902462799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 4721) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2019-05-16 |
| Last Update Date | 2023-09-13 |