| NPI | 1285367136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LAC-19684) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor (Licence: 466358) |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2022-07-07 |