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 |