| NPI | 1447418678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MI 6401008207) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MI 6401008207) | |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2008-05-23 |
| Last Update Date | 2018-02-08 |