| NPI | 1245365113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA IMF58450) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: CA 58450) |
| 106H00000X Marriage & Family Therapist (Licence: CA 58450) | |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2011-02-04 |