| NPI | 1679961593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA PSB94020785) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA PSB94020785) |
| Enumeration Date | 2014-12-30 |
| Last Update Date | 2014-12-30 |