| NPI | 1407249907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CO LPC.0016946) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CO LPCC.0014828) |
| 101YM0800X Counselor Mental Health (Licence: CO ADDC.0000015) | |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2021-09-14 |