| NPI | 1215548086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 112103) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-08-13 |
| Last Update Date | 2023-07-04 |