| NPI | 1467962811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC21139) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LAC5883T) |
| Enumeration Date | 2017-10-11 |
| Last Update Date | 2024-03-12 |