| NPI | 1508425687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-20883) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LAC-18400) |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2022-04-23 |