| NPI | 1801279724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA 71488) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 71488) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2017-02-09 |