| NPI | 1407288103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401013680) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6401013680) | |
| 101YM0800X Counselor, Mental Health (Licence: MI 6401013680) | |
| 101YP2500X Counselor, Professional (Licence: CO LPC.0014257) | |
| 101YP2500X Counselor, Professional (Licence: MI 6401013680) | |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2023-03-14 |