| NPI | 1598472334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 9471) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL 256) |
| 101YM0800X Counselor, Mental Health (Licence: AZ 13836) | |
| Enumeration Date | 2022-11-01 |
| Last Update Date | 2022-11-09 |