| NPI | 1679217566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AZ LPC-21702) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ LAC-18113) |
| 101YP2500X Counselor, Professional (Licence: AZ LPC-21702) | |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2023-11-29 |