| NPI | 1396054920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401011162) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401011162) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6401011162) | |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2023-03-15 |