| NPI | 1538506324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CT 3295) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LAC-14147) |
| 101YP2500X Counselor, Professional (Licence: AZ LPC-15688) | |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2019-11-09 |