| NPI | 1891887741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL ADC-002751-2014) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 803321) |
| 101Y00000X Counselor (Licence: FL CBHT3258) | |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2021-02-17 |