| NPI | 1215319389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LPC14566) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2025-06-24 |