| NPI | 1104668151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0016944) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 101YP2500X Counselor, Professional (Licence: CO LPC0016944) | |
| Enumeration Date | 2024-06-11 |
| Last Update Date | 2026-09-15 |