| NPI | 1881005940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0014767) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 10237) |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2019-10-03 |