| NPI | 1437814662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA LMFT139628) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 124635) |
| 101Y00000X Counselor (Licence: CA 9331) | |
| 101YP2500X Counselor Professional (Licence: MI LPC6401223747) | |
| Enumeration Date | 2021-11-02 |
| Last Update Date | 2024-02-22 |