| NPI | 1841663143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW18946) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL SW18946) |
| 101YM0800X Counselor, Mental Health (Licence: FL SW18946) | |
| Enumeration Date | 2015-11-09 |
| Last Update Date | 2023-02-21 |