| NPI | 1306442181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-24002) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 11816985-6004) |
| Enumeration Date | 2020-12-08 |
| Last Update Date | 2025-09-09 |