| NPI | 1326243064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 53217) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA MFTI 52690) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2019-08-22 |