| NPI | 1063041861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0017441) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180.012832) |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2022-09-22 |