| NPI | 1710494638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO LPC.0019773) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2017-12-30 |
| Last Update Date | 2023-09-11 |