| NPI | 1003501289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0024248) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO LPC.0024248) |
| 101YM0800X Counselor, Mental Health (Licence: CO LPC.0024248) | |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2026-08-19 |