| NPI | 1083087100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-15858) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ LPC15858) |
| 101Y00000X Counselor (Licence: AZ LPC-15858) | |
| Enumeration Date | 2015-11-11 |
| Last Update Date | 2024-02-29 |