| NPI | 1861577710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 3706) |
| 101YP2500X Counselor, Professional (Licence: CO LPC.0003706) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2020-12-16 |