| NPI | 1386150738 |
|---|---|
| Former Name | KRYSTOFFER LOREN GAETA |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO 0015508) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0015508) |
| Enumeration Date | 2017-12-21 |
| Last Update Date | 2024-03-25 |