| NPI | 1538833223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801117636) |
| Enumeration Date | 2021-08-05 |
| Last Update Date | 2024-09-11 |