| NPI | 1518037084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401005673) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6401005673) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI C-01181) | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2017-03-02 |