| NPI | 1093452732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0017080) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: HI MHC-860-0) |
| 101YM0800X Counselor, Mental Health (Licence: CO LPC.0017080) | |
| Enumeration Date | 2022-05-15 |
| Last Update Date | 2024-02-20 |