| NPI | 1063277010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CO LPC.0014000) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0014000) |
| 101YP2500X Counselor, Professional (Licence: CO LPC.0014000) | |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2024-03-06 |