NPI | 1649830795 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 13497) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA APCC5863) |
Enumeration Date | 2019-06-19 |
Last Update Date | 2023-03-24 |