| NPI | 1538202635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 49290) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2011-05-05 |