| NPI | 1427177898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AZ LPC-10836) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AZ LPC - 10836) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2017-04-23 |