| NPI | 1407275563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0013550) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO NLC.0103958) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2025-05-20 |