| NPI | 1245605492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: FL MH13650) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL MH13650) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 5590) | |
| 101YM0800X Counselor, Mental Health (Licence: FL MH13650) | |
| 101YS0200X Counselor, School (Licence: FL MH13650) | |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: FL PMD509652) | |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2015-12-14 |