| NPI | 1003111337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 76736) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 101YM0800X Counselor, Mental Health (Licence: CA 30027) | |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2019-01-09 |