| NPI | 1467169086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0019148) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: CO LPC.0019148) |
| 101YM0800X Counselor, Mental Health (Licence: HI MHC-926) | |
| Enumeration Date | 2022-11-02 |
| Last Update Date | 2026-05-14 |