| NPI | 1568705366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC - 15744) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LAC14157) |
| Enumeration Date | 2013-03-29 |
| Last Update Date | 2015-08-22 |