| NPI | 1932198744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-1417) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ LPC-1417) |
| 101YP2500X Counselor, Professional (Licence: AZ LPC-1417) | |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2008-05-05 |