| NPI | 1942361779 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL CAP 1569) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW5967) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2007-07-08 |