| NPI | 1508248873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401015796) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI C-03253) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2016-12-16 |