| NPI | 1568567634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AZ LPC10074) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: AZ 10074) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2023-07-13 |