| NPI | 1629484035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AR P2601002) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 10298) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2026-03-03 |