NPI | 1649570656 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH9493) |
Additional Taxonomies | 101Y00000X Counselor (Licence: FL MH9493) |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MH9493) | |
Enumeration Date | 2010-10-25 |
Last Update Date | 2013-10-30 |