| NPI | 1407280068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-21048) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 8711060-6004) |
| Enumeration Date | 2013-08-30 |
| Last Update Date | 2024-05-08 |