| NPI | 1417393059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0014578) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 8491579-6009) |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2023-11-28 |