| NPI | 1861855769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AR P1901010) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AR A1603031) |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2024-09-18 |