| NPI | 1033566674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401007096) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401007096) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6401007096) | |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2026-03-23 |