| NPI | 1609382225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH15004) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0000453) |
| 101YP2500X Counselor, Professional (Licence: CO LPC.0012446) | |
| Enumeration Date | 2017-12-19 |
| Last Update Date | 2017-12-19 |