| 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 |