| NPI | 1962951004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-19450) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: HI MHC-613) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2016-09-30 |
| Last Update Date | 2023-12-01 |