| NPI | 1497304968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-18393) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LAC-15982) |
| Enumeration Date | 2019-09-08 |
| Last Update Date | 2019-09-23 |