NPI | 1962044826 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-22001) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-22001) |
Enumeration Date | 2019-10-11 |
Last Update Date | 2023-11-14 |