| NPI | 1073758926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 9693) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 1946) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 4614) | |
| Enumeration Date | 2008-12-06 |
| Last Update Date | 2009-07-20 |