| NPI | 1174059554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AR P1211104) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AR M1212012) |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2017-05-04 |