| NPI | 1013430834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH15250) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MS 1854) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MS 102) | |
| 104100000X Social Worker (Licence: FL MH15250) | |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2019-04-16 |