| NPI | 1407338379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA LPCC7234) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ LPC-17011) |
| Enumeration Date | 2018-09-06 |
| Last Update Date | 2019-11-26 |