| NPI | 1689804908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MS 2921) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 101YM0800X Counselor, Mental Health (Licence: CA 60105) | |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2024-07-03 |