| NPI | 1043693096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-15817) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LAC-14239) |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2016-01-25 |