| NPI | 1063088185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA 103339) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: UT 1131040-3501) |
| Enumeration Date | 2021-05-30 |
| Last Update Date | 2022-05-31 |