| NPI | 1922128867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-18398) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NH 710) |
| Enumeration Date | 2007-03-31 |
| Last Update Date | 2024-10-11 |