| NPI | 1851828081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO LPC.0017137) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL IMH15754) |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2021-05-24 |