| NPI | 1316988603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL sap) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL mh5422) |
| 101YP2500X Counselor, Professional (Licence: FL mt1965) | |
| 101YS0200X Counselor, School (Licence: FL ss690) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2007-07-08 |