| NPI | 1285876409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 11142) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL ABC010814-215) |
| 101YP2500X Counselor, Professional (Licence: FL 6158) | |
| 171M00000X Case Manager/Care Coordinator (Licence: FL 131096) | |
| 171M00000X Case Manager/Care Coordinator (Licence: FL 689259179) | |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2018-09-27 |