| NPI | 1275048167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C5715) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LPC-13803) |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2021-04-08 |