| NPI | 1831609262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: AR P1804055) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AR M1804009) |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2020-04-04 |