| NPI | 1295238996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 5631) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL 5631) |
| 101YM0800X Counselor, Mental Health (Licence: FL 5631) | |
| Enumeration Date | 2018-03-09 |
| Last Update Date | 2018-03-09 |