| NPI | 1427871060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ 57467590232) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ 32445654) |
| 103TH0004X Psychologist, Health (Licence: CO 24114567) | |
| Enumeration Date | 2024-11-04 |
| Last Update Date | 2024-11-04 |