| NPI | 1114240181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401222438) |
| Enumeration Date | 2010-03-05 |
| Last Update Date | 2022-12-20 |