| NPI | 1518577790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA AMFT120524) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA APCC8154) |
| Enumeration Date | 2020-08-03 |
| Last Update Date | 2020-08-13 |