| NPI | 1972778686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 8662) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MH8662) |
| 101YP2500X Counselor, Professional (Licence: 216170) | |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2023-01-27 |