| NPI | 1568580124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0002246) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 0000) |
| 101YP2500X Counselor, Professional (Licence: CO 2246) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2021-02-15 |