| NPI | 1790106276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AR P0909057) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0000867) |
| Enumeration Date | 2013-12-30 |
| Last Update Date | 2022-08-17 |