| NPI | 1477866085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA LPC 412) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA LPC 412) |
| 101YM0800X Counselor, Mental Health (Licence: FL MH 10629) | |
| Enumeration Date | 2010-07-24 |
| Last Update Date | 2013-06-13 |