| NPI | 1588119481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 198) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: FL 5758) |
| 171W00000X Contractor (Licence: FL 449) | |
| Enumeration Date | 2016-08-20 |
| Last Update Date | 2016-08-20 |