| NPI | 1659908838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-22469) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LAC-18721) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2023-11-29 |