| NPI | 1003344094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0015143) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2026-04-08 |