| NPI | 1134876600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0019767) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0018666) |
| Enumeration Date | 2022-03-04 |
| Last Update Date | 2023-09-09 |