| NPI | 1598522476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-23001) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LAC-21119) |
| Enumeration Date | 2024-03-06 |
| Last Update Date | 2024-05-15 |