| NPI | 1326764408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0021490) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LPCC.0020137) |
| Enumeration Date | 2022-10-19 |
| Last Update Date | 2024-12-05 |