| NPI | 1053486555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA LPC 395) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA LPC 395) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2013-11-22 |