| NPI | 1104272244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA LPCC4340) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60684311) |
| Enumeration Date | 2016-05-08 |
| Last Update Date | 2021-08-31 |