| NPI | 1902276918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CO PSYC.00015099) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CO LPC.0016659) |
| Enumeration Date | 2015-10-02 |
| Last Update Date | 2022-10-11 |