| NPI | 1093789836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MH3098) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH3098) |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2011-01-11 |