| NPI | 1407297948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0012672) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0012672) |
| Enumeration Date | 2013-07-12 |
| Last Update Date | 2021-03-18 |