| NPI | 1306473814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AK 156870) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA LPCC18904) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2025-10-07 |