NPI | 1053939181 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA AMFT130549) |
Additional Taxonomies | 225400000X Rehabilitation Practitioner |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2020-07-06 |
Last Update Date | 2022-01-19 |