| NPI | 1669982138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 109624) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: UT 8090730-3506) |
| 1041C0700X Social Worker, Clinical (Licence: CA 109624) | |
| Enumeration Date | 2017-10-10 |
| Last Update Date | 2023-09-26 |