| NPI | 1942819081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK 7311) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LCSW-16148) |
| Enumeration Date | 2020-07-24 |
| Last Update Date | 2022-03-28 |