| NPI | 1942655824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA PSB94022347) |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2018-08-27 |