| NPI | 1629831417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0023545) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MO 2023036734) |
| 101YP2500X Counselor, Professional (Licence: MO 20205030280) | |
| Enumeration Date | 2024-02-05 |
| Last Update Date | 2026-07-13 |