| NPI | 1548772163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA 132638) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA IMF92067) |
| Enumeration Date | 2017-11-05 |
| Last Update Date | 2022-07-27 |