| NPI | 1275540676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 100826) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401008652) |
| 103TC0700X Psychologist, Clinical (Licence: MI 6301007806) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2007-07-08 |