| NPI | 1700996832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AR P0605031) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AR M0801002) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2012-04-04 |