| NPI | 1972923597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-10456) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LISAC-11721) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2014-04-22 |