| NPI | 1649237785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: AR P8209020) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: AR P8209020) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2009-05-19 |