| NPI | 1255789897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: CO NLC.0106360) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: CO NA.00742550) |
| 101YM0800X Counselor Mental Health (Licence: CO NLC.0106360) | |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2016-07-17 |