| NPI | 1174281448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0017716) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 0017716) |
| Enumeration Date | 2021-12-03 |
| Last Update Date | 2023-12-04 |