| NPI | 1003056938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AR A1012137) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 106H00000X Marriage & Family Therapist (Licence: AR A1109014) | |
| Enumeration Date | 2009-03-05 |
| Last Update Date | 2012-12-18 |