| NPI | 1134633548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA LPCC9551) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA LPCC9551) |
| 101YM0800X Counselor Mental Health (Licence: CA PCCI4572) | |
| Enumeration Date | 2017-11-21 |
| Last Update Date | 2021-05-18 |