| NPI | 1326788639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO LPC.0022722) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO LPCC.0018780) |
| Enumeration Date | 2022-04-01 |
| Last Update Date | 2025-08-21 |