| NPI | 1962095398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CO LPC.0018940) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0018053) |
| 101YM0800X Counselor, Mental Health (Licence: CO LPC.0018940) | |
| Enumeration Date | 2021-02-17 |
| Last Update Date | 2023-05-24 |