| NPI | 1154152379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO LPC.0021157) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO LPCC.0019666) |
| Enumeration Date | 2024-08-09 |
| Last Update Date | 2024-08-20 |