| NPI | 1578037990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-15856) |
| Enumeration Date | 2019-01-18 |
| Last Update Date | 2026-02-04 |