| NPI | 1275035438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MH9959) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH9959) |
| 183500000X Pharmacist (Licence: FL PS27315) | |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2018-03-05 |