| NPI | 1093731259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-18005) |
| Additional Taxonomies | 104100000X Social Worker (Licence: FL MH2815) |
| 101YM0800X Counselor, Mental Health (Licence: FL MH2815) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2022-10-20 |