| NPI | 1023047685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6401004824) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401004824) |
| 101YM0800X Counselor, Mental Health (Licence: MI 6401004824) | |
| 101YP2500X Counselor, Professional (Licence: MI 6401004824) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2019-05-15 |