| NPI | 1356881544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL SW13870) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL SW13870) |
| 101YP2500X Counselor Professional (Licence: FL SW13870) | |
| 101Y00000X Counselor (Licence: FL SW13870) | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: FL SW13870) | |
| Enumeration Date | 2017-03-07 |
| Last Update Date | 2019-09-17 |