| NPI | 1215181037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT 7269) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC-5227) |
| 101YP2500X Counselor, Professional (Licence: AZ LPC-11387) | |
| Enumeration Date | 2008-11-06 |
| Last Update Date | 2022-12-06 |