| NPI | 1376711424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH7984) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL CAP2781) |
| 103TF0200X Psychologist, Forensic (Licence: FL CCJS11250) | |
| Enumeration Date | 2008-02-12 |
| Last Update Date | 2020-03-25 |