| NPI | 1407191562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC 6008) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH9472) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID CADC 10268) | |
| 101YP2500X Counselor, Professional (Licence: ID LCPC 6008) | |
| Enumeration Date | 2012-11-30 |
| Last Update Date | 2016-07-25 |