| NPI | 1497365431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0016362) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0016362) |
| Enumeration Date | 2020-08-04 |
| Last Update Date | 2024-08-20 |