| NPI | 1558633040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: AR P1307078) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: AR P1307078) |
| Enumeration Date | 2012-01-31 |
| Last Update Date | 2024-03-14 |