| NPI | 1649751496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LPC-25061) |
| 101YP2500X Counselor, Professional (Licence: ID 6571869) | |
| Enumeration Date | 2018-08-28 |
| Last Update Date | 2026-09-01 |