| NPI | 1063960458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AR P1804050) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AR A1606078) |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2021-10-15 |