| NPI | 1740627074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0012774) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: CO 0000000000) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2021-03-15 |