NPI | 1528616794 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 97361) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-08-29 |
Last Update Date | 2020-10-05 |