| NPI | 1700237096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH14555) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL ADC-011482-2015) |
| 101YM0800X Counselor, Mental Health (Licence: FL MH14560) | |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2019-12-10 |