| NPI | 1487098224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA LPCC3429) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YP2500X Counselor Professional (Licence: CA LPCC) | |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2021-05-19 |