| NPI | 1972050128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL LPC-05035) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 72298) |
| 101YP2500X Counselor, Professional (Licence: AZ LPC-21194) | |
| Enumeration Date | 2016-09-06 |
| Last Update Date | 2025-02-21 |