| NPI | 1730706227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSYC.00016146) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2025-09-11 |