| NPI | 1558759068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-10550) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LPC10550) |
| Enumeration Date | 2015-01-06 |
| Last Update Date | 2025-06-30 |