| NPI | 1356561765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TN 3153) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health (Licence: FL MH 10329) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2015-10-10 |