| NPI | 1336604602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0021291) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPCC.0019375) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2019-01-31 |
| Last Update Date | 2025-12-10 |