| NPI | 1457878647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH20179) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MCAP.0101178) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 2486) | |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2026-02-25 |