| NPI | 1780716910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA ASW73971) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW17358) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2017-02-03 |