| NPI | 1205143625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 149189) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 101Y00000X Counselor | |
| Enumeration Date | 2010-09-07 |
| Last Update Date | 2025-01-27 |