| NPI | 1538627419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-17947) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ LPC-17947) |
| 101YM0800X Counselor, Mental Health (Licence: AZ LPC-17947) | |
| Enumeration Date | 2019-03-09 |
| Last Update Date | 2025-10-30 |