| NPI | 1205079753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH7499) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: FL 1602) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: FL 15597) | |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2009-04-14 |