| NPI | 1730459710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-16970) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ lpc-16970) |
| Enumeration Date | 2012-01-06 |
| Last Update Date | 2024-07-08 |