| NPI | 1295159176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 87526) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-02-12 |
| Last Update Date | 2021-01-05 |