| NPI | 1770568388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-18875) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ID LCPC-3852) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2024-04-14 |