| NPI | 1356580666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AR P1710360) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: P1104025) |
| Enumeration Date | 2009-02-10 |
| Last Update Date | 2022-04-01 |