| NPI | 1699249649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0017199) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0016220) |
| Enumeration Date | 2019-01-13 |
| Last Update Date | 2021-10-26 |