| NPI | 1144468257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL SW9271) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: FL SW9271) |
| 101YM0800X Counselor Mental Health (Licence: FL SW9271) | |
| Enumeration Date | 2009-01-27 |
| Last Update Date | 2009-01-27 |