| NPI | 1073252664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-21037) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LAC-17236) |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2022-06-27 |