| NPI | 1659698736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: AR P2111008) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AR A1909134) |
| Enumeration Date | 2010-04-28 |
| Last Update Date | 2021-12-06 |