| NPI | 1558073338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 15998) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YM0800X Counselor, Mental Health (Licence: CA 15988) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-12-23 |
| Last Update Date | 2024-04-03 |