| NPI | 1609185453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW7468) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL SW7468) |
| 102L00000X Psychoanalyst (Licence: FL SW7468) | |
| 106H00000X Marriage & Family Therapist (Licence: FL SW7468) | |
| 171M00000X Case Manager/Care Coordinator (Licence: FL SW7468) | |
| 174H00000X Health Educator (Licence: FL MPH) | |
| Enumeration Date | 2010-09-28 |
| Last Update Date | 2015-05-05 |