| NPI | 1356093819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH23929) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 0101179) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 0000202) | |
| 251B00000X Case Management (Licence: FL CBHCM103991) | |
| Enumeration Date | 2022-01-25 |
| Last Update Date | 2024-08-28 |