| NPI | 1255843652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QC1500X Clinic/Center Community Health (Licence: FL MCAP100646) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL CMHP100005) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: FL ADC-002941-2014) | |
| 101YP2500X Counselor Professional (Licence: FL ADC-002941-2014) | |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2019-05-13 |