| NPI | 1265765259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 87343) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO 09923823) |
| Enumeration Date | 2009-09-09 |
| Last Update Date | 2023-11-15 |