| NPI | 1316911936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI NCACII001480) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI LPC6401002033) |
| 101YM0800X Counselor, Mental Health (Licence: MI CSW6801010818) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2024-06-15 |