| NPI | 1013373760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL ADC-010480-2015) |
| Additional Taxonomies | 251S00000X (Licence: FL ADC-010480-2015) |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2016-01-11 |