| NPI | 1174166730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ 21161) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 0016631) |
| Enumeration Date | 2019-10-25 |
| Last Update Date | 2022-07-27 |