| NPI | 1780217000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0017563) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0016610) |
| Enumeration Date | 2020-02-14 |
| Last Update Date | 2021-09-26 |