| NPI | 1225466618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-15266) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ LPC-15266) |
| Enumeration Date | 2013-10-22 |
| Last Update Date | 2025-12-18 |