| NPI | 1053348474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AR P0512077) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AR 0299L) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2023-08-01 |