| NPI | 1407163199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW9542) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL SW9542) |
| 101YM0800X Counselor, Mental Health (Licence: FL SW9542) | |
| 101YP1600X Counselor, Pastoral (Licence: FL SW 9542) | |
| Enumeration Date | 2010-09-02 |
| Last Update Date | 2020-09-21 |