| NPI | 1295063931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-19023) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WY LPC 1628) |
| Enumeration Date | 2009-11-18 |
| Last Update Date | 2024-09-26 |