NPI | 1124790118 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 16451) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 16451) |
Enumeration Date | 2021-09-29 |
Last Update Date | 2024-09-20 |