| NPI | 1679309686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-08058T) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 11017-125) |
| Enumeration Date | 2024-09-09 |
| Last Update Date | 2024-09-09 |