| NPI | 1568121523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0020322) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2021-12-16 |
| Last Update Date | 2024-02-16 |