| NPI | 1982792057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA 12959) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA CA12959) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2021-09-17 |