| NPI | 1093741902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AR P0809070) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AR A0510075) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2018-01-10 |