| NPI | 1679232185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0020149) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPCC.0019089) |
| Enumeration Date | 2021-12-12 |
| Last Update Date | 2024-11-07 |