| NPI | 1437525789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0018930) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0018047) |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2025-03-05 |