| NPI | 1982972972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0014428) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 11358) |
| Enumeration Date | 2011-12-06 |
| Last Update Date | 2023-10-26 |