| NPI | 1891173019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AR A1504054) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AR F1504007) |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2015-05-07 |