| NPI | 1053959239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-19959) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C4610) |
| Enumeration Date | 2019-12-18 |
| Last Update Date | 2026-09-01 |