| NPI | 1619233624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LAC-13787) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ 15933) |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2021-03-22 |