| NPI | 1700631785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO 13038) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TN 7320) |
| 101YP2500X Counselor Professional (Licence: NE 2336) | |
| 101YP2500X Counselor Professional (Licence: IA 085169) | |
| 101YP2500X Counselor Professional (Licence: NE 1677) | |
| 103TC0700X Psychologist Clinical (Licence: KS 071) | |
| Enumeration Date | 2024-04-22 |
| Last Update Date | 2024-10-09 |