| NPI | 1811245954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH11868) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VI 1-43693-1B) |
| 101YP2500X Counselor, Professional (Licence: VI 1-43693-1B) | |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2024-10-27 |