| NPI | 1639596968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: FL CMHP#50161) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL CAP#2288) |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2022-03-31 |