| NPI | 1770180994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0018979) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0017499) |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2023-01-02 |