| NPI | 1669034096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LPC.0017510) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0001288) |
| 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0017094) | |
| Enumeration Date | 2019-07-06 |
| Last Update Date | 2023-03-10 |