| NPI | 1265941090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AR PO103013) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AR PO103013) |
| Enumeration Date | 2017-09-25 |
| Last Update Date | 2018-06-16 |