| NPI | 1215584115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-21819) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LAC-17463) |
| 101Y00000X Counselor (Licence: AZ LPC-21819) | |
| Enumeration Date | 2019-08-25 |
| Last Update Date | 2023-10-06 |