| NPI | 1386004679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 86385) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor |
| 101Y00000X Counselor | |
| Enumeration Date | 2016-02-29 |
| Last Update Date | 2018-10-24 |