| NPI | 1326547282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC20980) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ pending) |
| 101YM0800X Counselor, Mental Health (Licence: AZ pending) | |
| Enumeration Date | 2018-02-06 |
| Last Update Date | 2022-05-20 |