| NPI | 1306601471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C6465) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LPC-23474) |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2026-05-14 |