| NPI | 1134890916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC A16905) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO LPC.0020024) |
| 101Y00000X Counselor (Licence: NC A16905) | |
| 101YM0800X Counselor, Mental Health (Licence: CO LPC.0020024) | |
| 101YM0800X Counselor, Mental Health (Licence: NC A16905) | |
| 101YP2500X Counselor, Professional (Licence: CO LPC.0020024) | |
| Enumeration Date | 2021-09-22 |
| Last Update Date | 2024-02-01 |