| NPI | 1609005883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 4859) | |
| 101Y00000X Counselor | |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2016-08-16 |