| NPI | 1811370844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: AZ LPC-15865) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AZ 15865) |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2018-07-17 |