| NPI | 1861107062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0020787) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0019503) |
| Enumeration Date | 2023-01-23 |
| Last Update Date | 2024-07-27 |