| NPI | 1134629769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0021716) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0019895) |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2025-01-28 |