| NPI | 1114551868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AR P2003029) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AR M2003002) |
| Enumeration Date | 2020-03-02 |
| Last Update Date | 2020-03-23 |