| NPI | 1316988603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| 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 |