| NPI | 1528232626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6803084972) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: MI 6803044972) |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2008-04-18 |