| NPI | 1063029916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: FL MH18425) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MCAP100273) |
| 101YP2500X Counselor, Professional (Licence: NV CP5607-R) | |
| Enumeration Date | 2020-09-24 |
| Last Update Date | 2024-01-04 |