| NPI | 1699913566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 60209) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 60209) |
| 101Y00000X Counselor | |
| Enumeration Date | 2009-01-29 |
| Last Update Date | 2014-08-07 |