| NPI | 1689268856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0022832) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0022832) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ADDC.0000418) | |
| 171400000X Health & Wellness Coach | |
| Enumeration Date | 2021-02-26 |
| Last Update Date | 2026-03-03 |