| NPI | 1649991969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA 111611) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2022-09-06 |
| Last Update Date | 2023-05-09 |