| NPI | 1841321106 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AR A1710299) | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AR F1710013) | 
| Enumeration Date | 2007-03-08 | 
| Last Update Date | 2018-07-30 |