| NPI | 1750714150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: AR P8708016) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AR M9807030) |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2013-08-21 |