| NPI | 1134510993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CO LPC.0012196) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0012196) |
| Enumeration Date | 2015-02-13 |
| Last Update Date | 2020-12-16 |