| NPI | 1457340044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AZ LPC0502) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: AZ LPC-0502) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2020-07-07 |