| NPI | 1942800073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0001081) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 1081) |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2020-11-11 |