| NPI | 1588029177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC14712) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AR A1512162) |
| Enumeration Date | 2015-12-23 |
| Last Update Date | 2025-06-02 |