| NPI | 1891119541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AZ LPC-16915) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AZ LAC-14391) |
| Enumeration Date | 2014-02-14 |
| Last Update Date | 2022-07-21 |