| NPI | 1538715180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AR P2209019) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: AR R029803) |
| Enumeration Date | 2019-08-09 |
| Last Update Date | 2024-01-12 |