| NPI | 1982371258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL ADC-005124-2014) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: FL CRPS.0101202.A) |
| 106S00000X Behavior Technician (Licence: FL CBHT.0100113) | |
| Enumeration Date | 2021-08-25 |
| Last Update Date | 2026-09-03 |