| NPI | 1265591234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: AZ LPC 10227) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: AZ 10227) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2011-01-28 |