| NPI | 1548247968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: FL MH5146) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: FL 2188) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2015-07-02 |