| NPI | 1356407738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 4355-120) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL PMH 1054) |
| 101YM0800X Counselor, Mental Health (Licence: WI 3932-125) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL CAP 5369) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2013-10-15 |