| NPI | 1245828847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CA 35125) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YS0200X Counselor School | |
| Enumeration Date | 2021-01-08 |
| Last Update Date | 2021-01-08 |