| NPI | 1407104078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AZ LPC17492) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2020-11-13 |