| NPI | 1841936127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-21358) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ LAC-18980) |
| 101Y00000X Counselor (Licence: AZ LPC-21358) | |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2024-09-25 |