| NPI | 1366787459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AR P1409066) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AR A1209078) |
| Enumeration Date | 2012-11-30 |
| Last Update Date | 2018-07-30 |