| NPI | 1710594668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA LPCC724) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NV CP1246-R) |
| 225C00000X Rehabilitation Counselor (Licence: 00115411) | |
| Enumeration Date | 2020-09-24 |
| Last Update Date | 2023-05-09 |