| NPI | 1972249902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-20787) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LPC-20787) |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2024-05-16 |