| NPI | 1891287298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AZ 22964) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AZ 16821) |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2024-04-17 |