| NPI | 1255585170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: MI 6802005233) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MI 1-03001) |
| Enumeration Date | 2008-11-05 |
| Last Update Date | 2008-11-05 |