| NPI | 1629783121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CO LPC.0019441) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0019441) |
| Enumeration Date | 2023-01-18 |
| Last Update Date | 2023-09-27 |