| NPI | 1023631330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0020329) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA LMHC.129630) |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2026-06-17 |