| NPI | 1518332683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 11936) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LPC-15870) |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2023-05-02 |