| NPI | 1780423012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-22940) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: AZ LPC-22940) |
| Enumeration Date | 2024-05-24 |
| Last Update Date | 2024-08-15 |