| NPI | 1598463663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ 21800) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LPC21800) |
| Enumeration Date | 2023-02-20 |
| Last Update Date | 2024-02-21 |