| NPI | 1053850636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0017386) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 00529-LC) |
| 101YM0800X Counselor, Mental Health (Licence: NM CTB-2023-0648) | |
| 101YM0800X Counselor, Mental Health (Licence: AZ LPC-21334) | |
| 101YM0800X Counselor, Mental Health (Licence: MO 202234677) | |
| 101YM0800X Counselor, Mental Health (Licence: NV CP5078-R) | |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2025-08-11 |