| NPI | 1104835750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 2-00571) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6802072553) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2007-07-08 |