| NPI | 1639743982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0018080) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0016871) |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2022-03-24 |