| NPI | 1932675717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-17949) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LAC-15799) |
| Enumeration Date | 2018-10-18 |
| Last Update Date | 2023-07-28 |