| NPI | 1932788569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO LPC.0019595) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CO LPCC0017011) |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2023-07-24 |