| NPI | 1013349208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: AR P1803024) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AR A1602015) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2013-07-30 |
| Last Update Date | 2018-11-13 |