| NPI | 1194228379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA PT40911) |
| Enumeration Date | 2018-03-14 |
| Last Update Date | 2018-06-21 |