| NPI | 1689063794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AR P1910124) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AR A1611134) |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2020-04-03 |