| NPI | 1144531302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701006676) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0718000280) |
| 101YM0800X Counselor, Mental Health (Licence: FL MH 7577) | |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2018-03-17 |