| NPI | 1881060804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AZ LPC-17764) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NJ 37PC00527600) |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2024-06-08 |