| NPI | 1801804471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: FL SW4780) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL SW4780) |
| 1041C0700X Social Worker Clinical (Licence: FL SW4780) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2007-07-08 |