| NPI | 1437481017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 9078) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 1626) |
| 101YP2500X Counselor, Professional (Licence: FL 2008C-0623) | |
| Enumeration Date | 2010-02-05 |
| Last Update Date | 2016-07-05 |