| NPI | 1992396451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: CO LPC.0016860) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 1041C0700X Social Worker Clinical (Licence: CO LPC.0016860) | |
| Enumeration Date | 2021-01-28 |
| Last Update Date | 2024-10-10 |