| NPI | 1427665041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0018623) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0017799) |
| Enumeration Date | 2020-09-28 |
| Last Update Date | 2022-11-07 |