| NPI | 1164053203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-18495) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ LPC-18495) |
| 101YP2500X Counselor, Professional (Licence: DE PC-0000719) | |
| Enumeration Date | 2020-01-28 |
| Last Update Date | 2020-01-28 |