| NPI | 1396842738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW7675) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL SW7675) |
| 101YM0800X Counselor, Mental Health (Licence: OH I.2203632) | |
| 101YM0800X Counselor, Mental Health (Licence: MA 125002) | |
| 101YM0800X Counselor, Mental Health (Licence: FL SW7675) | |
| 106H00000X Marriage & Family Therapist (Licence: FL SW7675) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2023-02-09 |