| NPI | 1477024305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH16174) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MH16174) |
| 101YP2500X Counselor, Professional (Licence: FL MH16174) | |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2024-02-26 |