| NPI | 1275168338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL CAC100256) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 405300000X Prevention Professional (Licence: FL CAC100256) | |
| Enumeration Date | 2020-03-10 |
| Last Update Date | 2020-06-16 |