NPI | 1417596461 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 11457) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA APCC7205) |
Enumeration Date | 2019-12-22 |
Last Update Date | 2022-05-04 |