| NPI | 1730417478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0011755) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC0011755) |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional (Licence: CO LPC.0011755) | |
| Enumeration Date | 2009-11-18 |
| Last Update Date | 2022-03-17 |