| NPI | 1518455500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-21128) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM CMH0194921) |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2022-12-05 |