| NPI | 1619426046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 4902) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL 15419) |
| 101YP2500X Counselor, Professional (Licence: CA APCC4902) | |
| Enumeration Date | 2016-09-27 |
| Last Update Date | 2020-01-22 |