| NPI | 1568718682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW8346) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL CAP4290) |
| 101YM0800X Counselor, Mental Health (Licence: FL SW8346) | |
| Enumeration Date | 2012-07-26 |
| Last Update Date | 2014-06-02 |