| NPI | 1154742070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: FL CBHCMS100798) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 5444) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MCAP100381) | |
| 101YM0800X Counselor, Mental Health (Licence: FL IMH20336) | |
| Enumeration Date | 2013-12-19 |
| Last Update Date | 2021-03-24 |