| NPI | 1134634884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 10276) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 10276) |
| 101YM0800X Counselor, Mental Health (Licence: CA PCCI4283) | |
| Enumeration Date | 2017-12-04 |
| Last Update Date | 2021-10-01 |