| NPI | 1710141130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: FL MH8202) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MH8202) |
| 101YM0800X Counselor, Mental Health (Licence: FL MH8202) | |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2009-04-28 |