| NPI | 1225485246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AR P2507013) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LPC-08094T) |
| 101YP2500X Counselor, Professional (Licence: NV cp6380-R) | |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2026-08-19 |