| NPI | 1982286498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 13266) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 4244) |
| Enumeration Date | 2021-04-23 |
| Last Update Date | 2024-12-24 |