| NPI | 1679754063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: AR P1402016) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AR A0802015) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2022-08-11 |