| NPI | 1457878647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 2486) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH13092) |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2022-07-21 |