| NPI | 1639587769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW12105) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL SW12105) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL SW12105) | |
| 101YM0800X Counselor, Mental Health (Licence: FL SW12105) | |
| 101YP2500X Counselor, Professional (Licence: FL SW12105) | |
| 101YS0200X Counselor, School (Licence: FL SW12105) | |
| 103K00000X Behavior Analyst (Licence: FL SW12105) | |
| 104100000X Social Worker (Licence: FL SW12105) | |
| 1041S0200X Social Worker, School (Licence: FL SW12105) | |
| Enumeration Date | 2014-08-01 |
| Last Update Date | 2023-04-10 |