| NPI | 1285010587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0014105) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 70484) |
| 101YP2500X Counselor, Professional (Licence: CO LPC.0014105) | |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2018-03-17 |