| NPI | 1215578612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0018144) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0018144) |
| 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0017851) | |
| Enumeration Date | 2019-10-07 |
| Last Update Date | 2024-11-19 |