| NPI | 1144645920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AR P1705301) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AR M1709028) |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2014-03-03 |
| Last Update Date | 2023-04-01 |