| NPI | 1073167581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA LPCC13958) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YM0800X Counselor, Mental Health (Licence: CA APCC9405) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2024-02-02 |