| NPI | 1689243826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: 98357) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 98357) |
| Enumeration Date | 2021-06-22 |
| Last Update Date | 2023-06-12 |