| 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 |