| NPI | 1447980461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CO LPC.0021954) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101Y00000X Counselor (Licence: CO LPCC.0020347) | |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2025-03-21 |