| NPI | 1104303338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AR A1804044) |
| 101YM0800X Counselor, Mental Health (Licence: AR P2008056) | |
| Enumeration Date | 2018-07-20 |
| Last Update Date | 2022-07-29 |