| NPI | 1639244395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AR P1012078) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AR A0801006) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2013-03-21 |