| NPI | 1598114837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH12057) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL MH12057) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: FL MH12057) | |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2019-07-17 |