| NPI | 1538484910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH7581) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL MH7581) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MH7581) | |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2015-01-28 |