| NPI | 1205175791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801046519) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6801046519) |
| 101YP2500X Counselor, Professional (Licence: MI 6801046519) | |
| 106H00000X Marriage & Family Therapist (Licence: MI 6801046519) | |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2013-02-05 |