| NPI | 1215404439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 108203) |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2024-07-16 |