| NPI | 1821305632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AZ LPC-17269) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 63989) |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2018-07-27 |