| NPI | 1841517919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO PSY.0004248) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO PSY.0004248) |
| 101YM0800X Counselor, Mental Health | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-28 |
| Last Update Date | 2015-10-15 |