| NPI | 1639985005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 11714) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 11714) |
| 225C00000X Rehabilitation Counselor (Licence: CA 543553) | |
| Enumeration Date | 2024-12-10 |
| Last Update Date | 2024-12-10 |