| NPI | 1497270599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH19591) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: FL CBHCMS101234) |
| 101Y00000X Counselor (Licence: FL MH19591) | |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2026-05-05 |