| NPI | 1730232216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: P1006034) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AR A0602011) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2023-12-15 |