| NPI | 1396766945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: 101713) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301002425) |
| 104100000X Social Worker (Licence: MI 6801012814) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2007-07-08 |