| NPI | 1831540210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-21792) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0016856) |
| 101YP2500X Counselor, Professional (Licence: NM CCMH0206221) | |
| 101YM0800X Counselor, Mental Health (Licence: NM CCMH0206221) | |
| 101YP2500X Counselor, Professional (Licence: CO LPC.0016856) | |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2023-11-20 |