| NPI | 1083838379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 45915) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA MFC45915) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2018-07-05 |