| NPI | 1255472452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA MFC 41511) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: HI MFT #138) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2011-12-20 |