| NPI | 1265832331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-16539) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ LAC-13859) |
| Enumeration Date | 2014-08-26 |
| Last Update Date | 2025-04-05 |