| NPI | 1841414547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 5548) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 5548) |
| 103T00000X Psychologist (Licence: FL 5548) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2015-01-21 |