| NPI | 1871504910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: FL 5047) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 2399) |
| 101YM0800X Counselor, Mental Health (Licence: FL 05047) | |
| 103K00000X Behavior Analyst (Licence: FL 1-00-0254) | |
| 251B00000X Case Management (Licence: FL 05047) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2017-04-07 |