| NPI | 1831721042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0019741) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-18537) |
| Enumeration Date | 2020-02-05 |
| Last Update Date | 2023-10-09 |