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 | 2024-09-26 |