| NPI | 1689834434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 29011) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA PT29011) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2023-12-06 |