| NPI | 1093459075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AZ LPC-21793) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ LAC-19054) |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2023-12-06 |