| NPI | 1295103851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-17249) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ 15425) |
| Enumeration Date | 2015-09-11 |
| Last Update Date | 2024-01-09 |