| NPI | 1245505395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-23108) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LPC-23108) |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2025-05-24 |