| NPI | 1972806776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 10168) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ID LPC-4558) |
| Enumeration Date | 2010-12-16 |
| Last Update Date | 2023-06-07 |