| NPI | 1194121483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6401013216) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401013216) |
| 101YM0800X Counselor, Mental Health (Licence: MI 6401013216) | |
| 101YP2500X Counselor, Professional (Licence: MI 6401013216) | |
| Enumeration Date | 2014-11-13 |
| Last Update Date | 2023-03-01 |