| NPI | 1629770904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA LPCC10824) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AZ LPC-19640) |
| 101YM0800X Counselor Mental Health (Licence: TX 66158) | |
| 101YP2500X Counselor Professional (Licence: AZ LPC-19640) | |
| 101YP2500X Counselor Professional (Licence: TX 66158) | |
| 101YP2500X Counselor Professional (Licence: CA LPCC10824) | |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2023-03-20 |