| NPI | 1417560806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-20565) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AR P2501015) |
| 101YM0800X Counselor, Mental Health (Licence: AZ 20565) | |
| Enumeration Date | 2020-08-26 |
| Last Update Date | 2025-01-15 |