| NPI | 1194827188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI #076486) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MI CAC#1-00218) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2015-06-02 |