| NPI | 1174102537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC19817) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LAC17606) |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2021-06-02 |