| NPI | 1427919208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LAC-23279) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP2500X Counselor, Professional (Licence: LAC-23279) | |
| 101YM0800X Counselor, Mental Health (Licence: AZ LAC-23279) | |
| Enumeration Date | 2025-11-20 |
| Last Update Date | 2025-11-20 |