| NPI | 1780753590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: AR P0606037) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AR M0606006) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2024-09-07 |