| NPI | 1578813572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW10950) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL CAP5125) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL ICADC126606) | |
| Enumeration Date | 2012-09-17 |
| Last Update Date | 2015-10-14 |