| NPI | 1316670656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0018594) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 005366) |
| Enumeration Date | 2022-07-05 |
| Last Update Date | 2022-09-20 |