| NPI | 1205316601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AR A1609122) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AR F1609014) |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2018-08-16 |