| NPI | 1871569624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AR P0802019) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AR A0505036) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2017-12-15 |