| NPI | 1831896299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0023848) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0023237) |
| Enumeration Date | 2023-02-15 |
| Last Update Date | 2026-05-13 |