| NPI | 1154618627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0019971) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ID LPC-9051) |
| 101YP2500X Counselor, Professional (Licence: CO LPC.0019971) | |
| 101YP2500X Counselor, Professional (Licence: WY LPC-2215) | |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2024-02-16 |