| NPI | 1477096725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA PT 34689) |
| Enumeration Date | 2016-11-18 |
| Last Update Date | 2020-11-09 |