| NPI | 1851710222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-17620) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LAC-14358) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2021-05-24 |