| NPI | 1487320214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 16962) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LPC-20151) |
| Enumeration Date | 2021-08-20 |
| Last Update Date | 2025-10-16 |