| NPI | 1114338811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AR P1704288) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AR A1404070) |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2018-08-06 |