NPI | 1356958185 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LAMFT-10565) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LAMFT-10565) |
Enumeration Date | 2020-09-25 |
Last Update Date | 2020-09-25 |