| NPI | 1811205438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA 1845) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CA 1845) |
| 1041C0700X Social Worker Clinical (Licence: MT 1504) | |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2016-01-04 |