| NPI | 1790368272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-23657) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2021015291) |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2025-04-14 |