NPI | 1497128987 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 7398) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 3636) |
Enumeration Date | 2015-11-05 |
Last Update Date | 2021-06-17 |