| NPI | 1184180655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-17622) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ lpc-17622) |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2025-12-04 |