| NPI | 1770085706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL IMH25011) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: FL CBHCMS100924) |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2025-05-22 |