| NPI | 1770816738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH17441) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MH17441) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-09-09 |
| Last Update Date | 2020-01-09 |