| NPI | 1699133660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH15485) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL MH15485) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MH15485) | |
| 101YP2500X Counselor, Professional (Licence: FL MH15485) | |
| Enumeration Date | 2016-02-05 |
| Last Update Date | 2018-06-05 |