| NPI | 1356881841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0013565) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LPC-18189) |
| 101YP2500X Counselor, Professional (Licence: OR C7208) | |
| Enumeration Date | 2017-03-02 |
| Last Update Date | 2026-04-28 |