| NPI | 1407279417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-17293) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LAC- 14483) |
| Enumeration Date | 2014-01-27 |
| Last Update Date | 2018-05-11 |