| NPI | 1114164092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH8360) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL ADC-010848-2015) |
| 106H00000X Marriage & Family Therapist (Licence: FL MT2349) | |
| Enumeration Date | 2009-01-14 |
| Last Update Date | 2022-02-12 |