| NPI | 1639578495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 11708) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 4667) |
| 101YP2500X Counselor, Professional (Licence: FL MH 11708) | |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2023-09-21 |