| NPI | 1578726642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR.0064453) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL 9185) |
| 101YP2500X Counselor, Professional (Licence: CO 4441) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2020-07-24 |