| NPI | 1215346515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH5827) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL MH5827) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL CAC 2321) | |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2014-08-12 |