| NPI | 1528436540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AR P1908004) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AR F1512018) |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2019-09-03 |