| NPI | 1750736955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH20423) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MCAP100638) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 2969) | |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2022-03-22 |