| NPI | 1639716020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 5692) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA 61122449) |
| 101YM0800X Counselor, Mental Health (Licence: UT 12605055-6004) | |
| 101YM0800X Counselor, Mental Health (Licence: AZ 20489) | |
| Enumeration Date | 2019-12-04 |
| Last Update Date | 2022-01-06 |