| NPI | 1962242347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 20245) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2024-05-31 |
| Last Update Date | 2025-10-01 |