| NPI | 1780137133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA LPCC4648) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA LPCC4648) |
| 101YP2500X Counselor, Professional (Licence: VA 0701006573) | |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2022-12-22 |