NPI | 1487069357 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0014382) |
Additional Taxonomies | 101Y00000X Counselor (Licence: CO MA Psychology) |
Enumeration Date | 2014-06-30 |
Last Update Date | 2022-02-07 |