| NPI | 1235512617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO .0016818) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LPC-22822) |
| 101YM0800X Counselor, Mental Health (Licence: WA LH61483937) | |
| Enumeration Date | 2015-07-03 |
| Last Update Date | 2026-03-21 |