| NPI | 1700835352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 8552) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MH-8552) |
| 101YM0800X Counselor, Mental Health (Licence: FL MH8552) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2025-01-30 |