| NPI | 1871194266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0019187) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 0019187) |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2026-06-05 |