| NPI | 1578592812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AR P0412055) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AR M0502004) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2016-07-13 |